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The Face as a Sensory Organ

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Book cover The Know-How of Face Transplantation

Abstract

The human face is a highly specialized organ which receives sensory information from the environment and transmits it to the cortex. The advent of facial transplantation has recently shown that excellent reconstruction of disfiguring defects can be achieved; thus, the expectations are now focused on functional recovery of the transplant. So far, restoration of the facial sensation has not received the same attention as the recovery of motor function. We describe the current knowledge of the sensory pathways of the human face and their respective functions, the available methods of sensory assessment, and the data on normal sensation. The topographical sensory anatomy of facial subunits is summarized, the trigemino-facial connections are illustrated, and the implications of these anatomical variations on facial allotransplantation are emphasized.

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References

  1. Dubernard JM, Lengele B, Morelon E, et al. Outcomes 18 months after the first human partial face transplantation. N Engl J Med. 2007;357:2451-2460.

    CAS  PubMed  Google Scholar 

  2. Lantieri L, Meningaud JP, Grimbert P, et al. Repair of the lower and middle parts of the face by composite tissue allotransplantation in a patient with massive plexiform neurofibroma: a 1-year follow-up study. Lancet. 2008;372:639-645.

    PubMed  Google Scholar 

  3. Guo S, Han Y, Zhang X, et al. Human facial allotransplantation: a 2-year follow-up study. Lancet. 2008;372:631-638.

    PubMed  Google Scholar 

  4. Siemionow M, Papay F, Alam D, et al. Near-total human face transplantation for a severely disfigured patient in the USA. Lancet. 2009;374:203-209.

    PubMed  Google Scholar 

  5. Rogers SN, Lowe D, Patel M, Brown JS, Vaughan ED. Clinical function after primary surgery for oral and oropharyngeal cancer: an 11-item examination. Br J Oral Maxillofac Surg. 2002;40:1-10.

    CAS  PubMed  Google Scholar 

  6. Ito T, Gomi H. Cutaneous mechanoreceptors contribute to the generation of a cortical reflex in speech. NeuroReport. 2007;18:907-910.

    PubMed  Google Scholar 

  7. Livermore A, Hummel T, Pauli E, Kobal G. Perception of olfactory and intranasal trigeminal stimuli following cutaneous electrical stimulation. Experientia. 1993;49:840-842.

    CAS  PubMed  Google Scholar 

  8. LeBlanc J, Blais B, Barabe B, Cote J. Effects of temperature and wind on facial temperature, heart rate, and sensation. J Appl Physiol. 1976;40:127-131.

    CAS  PubMed  Google Scholar 

  9. Loken LS, Wessberg J, Morrison I, McGlone F, Olausson H. Coding of pleasant touch by unmyelinated afferents in humans. Nat Neurosci. 2009;12:547-548.

    PubMed  Google Scholar 

  10. Connor NP, Abbs JH. Orofacial proprioception: analyses of cutaneous mechanoreceptor population properties using artificial neural networks. J Commun Disord. 1998;31:535-542. 553.

    CAS  PubMed  Google Scholar 

  11. Uchigasaki S, Suzuki H, Inoue K. Merkel cells in the vellus hair follicles of human facial skin: a study using confocal laser microscopy. J Dermatol. 2004;31:218-222.

    PubMed  Google Scholar 

  12. Johansson RS, Trulsson M, Olsson KA, Westberg KG. Mechanoreceptor activity from the human face and oral mucosa. Exp Brain Res. 1988;72:204-208.

    CAS  PubMed  Google Scholar 

  13. Nordin M, Thomander L. Intrafascicular multi-unit recordings from the human infra-orbital nerve. Acta Physiol Scand. 1989;135:139-148.

    CAS  PubMed  Google Scholar 

  14. Bukowska M, Essick GK, Trulsson M. Functional properties of low-threshold mechanoreceptive afferents in the human labial mucosa. Exp Brain Res. 2010;201:59-64.

    CAS  PubMed  Google Scholar 

  15. Munger BL, Halata Z. The sensorineural apparatus of the human eyelid. Am J Anat. 1984;170:181-204.

    CAS  PubMed  Google Scholar 

  16. Kawakami T, Ishihara M, Mihara M. Distribution density of intraepidermal nerve fibers in normal human skin. J Dermatol. 2001;28:63-70.

    CAS  PubMed  Google Scholar 

  17. Johansson O, Wang L, Hilliges M, Liang Y. Intraepidermal nerves in human skin: PGP 9.5 immunohistochemistry with special reference to the nerve density in skin from different body regions. J Peripher Nerv Syst. 1999;4:43-52.

    CAS  PubMed  Google Scholar 

  18. Schulze E, Witt M, Fink T, Hofer A, Funk RH. Immunohistochemical detection of human skin nerve fibers. Acta Histochem. 1997;99:301-309.

    CAS  PubMed  Google Scholar 

  19. Kesarwani A, Antonyshyn O, Mackinnon SE, Gruss JS, Novak C, Kelly L. Facial sensibility testing in the normal and posttraumatic population. Ann Plast Surg. 1989;22:416-425.

    CAS  PubMed  Google Scholar 

  20. Fogaca WC, Sturtz GP, Surjan RC, Ferreira MC. Evaluation of cutaneous sensibility on infraorbital nerve area. J Craniofac Surg. 2005;16:953-956.

    PubMed  Google Scholar 

  21. Nordin M, Hagbarth KE. Mechanoreceptive units in the human infra-orbital nerve. Acta Physiol Scand. 1989;135:149-161.

    CAS  PubMed  Google Scholar 

  22. Davies SN, Goldsmith GE, Hellon RF, Mitchell D. Facial sensitivity to rates of temperature change: neurophysiological and psychophysical evidence from cats and humans. J Physiol. 1983;344:161-175.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Nordin M. Low-threshold mechanoreceptive and nociceptive units with unmyelinated (C) fibres in the human supraorbital nerve. J Physiol. 1990;426:229-240.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Chen CC, Rainville P, Bushnell MC. Noxious and innocuous cold discrimination in humans: evidence for separate afferent channels. Pain. 1996;68:33-43.

    CAS  PubMed  Google Scholar 

  25. Bushnell MC, Taylor MB, Duncan GH, Dubner R. Discrimination of innocuous and noxious thermal stimuli applied to the face in human and monkey. Somatosens Res. 1983;1:119-129.

    CAS  PubMed  Google Scholar 

  26. Gardner EP, Martin JH, Jessell TM. The bodily senses. In: Kandel ER, Schwartz JH, Jessell TM, eds. Principles of Neural Science. 4th ed. United States of America: McGraw-Hill; 2000:430-450.

    Google Scholar 

  27. Brannagan TH, Weimer LH. Cranial and peripheral nerve lesions. In: Rowland LP, Pedley TA, eds. Merritt’s Neurology. 12th ed. Philadelphia: Lippincott Williams & Wilkins; 2010:506.

    Google Scholar 

  28. Laine FJ, Smoker WR. Anatomy of the cranial nerves. Neuroimaging Clin North Am. 1998;8:69-100.

    CAS  Google Scholar 

  29. Nemzek WR. The trigeminal nerve. Top Magn Reson Imaging. 1996;8:132-154.

    CAS  PubMed  Google Scholar 

  30. Ropper AH, Samuels MA. Chapter 9: Other somatic sensation. In: Ropper AH, Samuels MA, eds. Adams and Victor’s Principles of Neurology. 9th ed. New York: McGraw-Hill; 2009.

    Google Scholar 

  31. Eriksen K. Neurophysiology and the upper cervical subluxation. In: Eriksen K, Rochester RP, eds. Orthospinology Procedures: An Evidenced-Based Approach to Spinal Care. 1st ed. Philadelphia: Lippincott William & Wilkins; 2007:183-207.

    Google Scholar 

  32. Terman GW, Bonica JJ. Spinal mechanisms and their modulation. In: Loeser JD, ed. Bonica’s Management of Pain. 3rd ed. Philadelphia: Lippincott William & Wilkins; 2001:110-125.

    Google Scholar 

  33. Penfield W, Boldrey E. Somatic motor and sensory representation in the cerebral cortex of man as studied by electrical stimulation. Brain. 1937;60:389-433.

    Google Scholar 

  34. Tamura Y, Shibukawa Y, Shintani M, Kaneko Y, Ichinohe T. Oral structure representation in human somatosensory cortex. Neuroimage. 2008;43:128-135.

    PubMed  Google Scholar 

  35. Nguyen BT, Inui K, Hoshiyama M, Nakata H, Kakigi R. Face representation in the human secondary somatosensory cortex. Clin Neurophysiol. 2005;116:1247-1253.

    PubMed  Google Scholar 

  36. Servos P, Engel SA, Gati J, Menon R. fMRI evidence for an inverted face representation in human somatosensory cortex. NeuroReport. 1999;10:1393-1395.

    CAS  PubMed  Google Scholar 

  37. Nguyen BT, Tran TD, Hoshiyama M, Inui K, Kakigi R. Face representation in the human primary somatosensory cortex. Neurosci Res. 2004;50:227-232.

    PubMed  Google Scholar 

  38. Namking M, Boonruangsri P, Woraputtaporn W, Guldner FH. Communication between the facial and auriculotemporal nerves. J Anat. 1994;185(Pt 2):421-426.

    PubMed  PubMed Central  Google Scholar 

  39. Kwak HH, Park HD, Youn KH, et al. Branching patterns of the facial nerve and its communication with the auriculotemporal nerve. Surg Radiol Anat. 2004;26:494-500.

    CAS  PubMed  Google Scholar 

  40. O’connell JE. The intraneural plexus and its significance. J Anat. 1936;70:468-497.

    PubMed  PubMed Central  Google Scholar 

  41. Huber E. Evolution of facial musculature and cutaneous field of trigeminus. Q Rev Biol. 1930;5:133-188.

    Google Scholar 

  42. Riessener D. Surgical procedure in tumors of parotid gland; preservation of facial nerve and prevention of postoperative fistulas. AMA Arch Surg. 1952;65:831-848.

    Google Scholar 

  43. Baumel JJ. Trigeminal-facial nerve communications. Their function in facial muscle innervation and reinnervation. Arch Otolaryngol. 1974;99:34-44.

    CAS  PubMed  Google Scholar 

  44. Carmichael EA, Woolard HH. Some observations on the fifth and seventh cranial nerves. Brain. 1933;56:109-125.

    Google Scholar 

  45. Ley A, Guitart JM. Clinical observations on sensory effects of trigeminal dorsal root section. J Neurol Neurosurg Psychiatry. 1971;34:260-264.

    CAS  PubMed  PubMed Central  Google Scholar 

  46. Costas PD, Heatley G, Seckel BR. Normal sensation of the human face and neck. Plast Reconstr Surg. 1994;93:1141-1145.

    CAS  PubMed  Google Scholar 

  47. Dellon AL, Andonian E, DeJesus RA. Measuring sensibility of the trigeminal nerve. Plast Reconstr Surg. 2007;120:1546-1550.

    CAS  PubMed  Google Scholar 

  48. Chen CC, Essick GK, Kelly DG, Young MG, Nestor JM, Masse B. Gender-, side- and site-dependent variations in human perioral spatial resolution. Arch Oral Biol. 1995;40:539-548.

    CAS  PubMed  Google Scholar 

  49. Vriens JP, van der Glas HW. Extension of normal values on sensory function for facial areas using clinical tests on touch and two-point discrimination. Int J Oral Maxillofac Surg. 2009;38:1154-1158.

    CAS  PubMed  Google Scholar 

  50. Green BG, Gelhard B. Perception of temperature on oral and facial skin. Somatosens Res. 1987;4:191-200.

    CAS  PubMed  Google Scholar 

  51. Rath EM, Essick GK. Perioral somesthetic sensibility: do the skin of the lower face and the midface exhibit comparable sensitivity? J Oral Maxillofac Surg. 1990;48:1181-1190.

    CAS  PubMed  Google Scholar 

  52. Hung J, Samman N. Facial skin sensibility in a young healthy Chinese population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107:776-781.

    PubMed  Google Scholar 

  53. Kawano T, Kabasawa Y, Ashikawa S, Sato Y, Jinno S, Omura K. Accuracy and reliability of thermal threshold measurement in the chin using heat flux technique. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108:500-504.

    PubMed  Google Scholar 

  54. Shimizu S, Osawa S, Utsuki S, Oka H, Fujii K. Course of the bony canal associated with high-positioned supraorbital foramina: an anatomic study to facilitate safe mobilization of the supraorbital nerve. Minim Invasive Neurosurg. 2008;51:119-123.

    CAS  PubMed  Google Scholar 

  55. Siemionow M, Papay F, Kulahci Y, et al. Coronal-posterior approach for face/scalp flap harvesting in preparation for face transplantation. J Reconstr Microsurg. 2006;22:399-405.

    PubMed  Google Scholar 

  56. Siemionow M, Agaoglu G, Unal S. A cadaver study in preparation for facial allograft transplantation in humans: part II. Mock facial transplantation. Plast Reconstr Surg. 2006;117:876-885. Discussion 886-888.

    CAS  PubMed  Google Scholar 

  57. Kubota K, Masegi T. Muscle spindle supply to the human jaw muscle. J Dent Res. 1977;56:901-909.

    CAS  PubMed  Google Scholar 

  58. Trulsson M, Johansson RS. Orofacial mechanoreceptors in humans: encoding characteristics and responses during natural orofacial behaviors. Behav Brain Res. 2002;135:27-33.

    PubMed  Google Scholar 

  59. Borsook D, Becerra L, Fishman S, et al. Acute plasticity in the human somatosensory cortex following amputation. NeuroReport. 1998;9:1013-1017.

    CAS  PubMed  Google Scholar 

  60. Wall JT, Xu J, Wang X. Human brain plasticity: an emerging view of the multiple substrates and mechanisms that cause cortical changes and related sensory dysfunctions after injuries of sensory inputs from the body. Brain Res Brain Res Rev. 2002;39:181-215.

    CAS  PubMed  Google Scholar 

  61. Neugroschl C, Denolin V, Schuind F, et al. Functional MRI activation of somatosensory and motor cortices in a hand-grafted patient with early clinical sensorimotor recovery. Eur Radiol. 2005;15:1806-1814.

    CAS  PubMed  Google Scholar 

  62. Brenneis C, Loscher WN, Egger KE, et al. Cortical motor activation patterns following hand transplantation and replantation. J Hand Surg Br. 2005;30:530-533.

    CAS  PubMed  Google Scholar 

  63. Farne A, Roy AC, Giraux P, Dubernard JM, Sirigu A. Face or hand, not both: perceptual correlates of reafferentation in a former amputee. Curr Biol. 2002;12:1342-1346.

    CAS  PubMed  Google Scholar 

  64. Shankland WE. The trigeminal nerve. Part II: the ophthalmic division. Cranio. 2001;19:8-12.

    CAS  PubMed  Google Scholar 

  65. Kimura K. Foramina and notches on the supraorbital margin in some racial groups. Kaibogaku Zasshi. 1977;52:203-209.

    CAS  PubMed  Google Scholar 

  66. Webster RC, Gaunt JM, Hamdan US, Fuleihan NS, Giandello PR, Smith RC. Supraorbital and supratrochlear notches and foramina: anatomical variations and surgical relevance. Laryngoscope. 1986;96:311-315.

    CAS  PubMed  Google Scholar 

  67. Knize DM. Transpalpebral approach to the corrugator supercilii and procerus muscles. Plast Reconstr Surg. 1995;95:52-60. Discussion 61-62.

    CAS  PubMed  Google Scholar 

  68. Malet T, Braun M, Fyad JP, George JL. Anatomic study of the distal supraorbital nerve. Surg Radiol Anat. 1997;19:377-384.

    CAS  PubMed  Google Scholar 

  69. Andersen NB, Bovim G, Sjaastad O. The frontotemporal peripheral nerves. topographic variations of the supraorbital, supratrochlear and auriculotemporal nerves and their possible clinical significance. Surg Radiol Anat. 2001;23:97-104.

    CAS  PubMed  Google Scholar 

  70. Beer GM, Putz R, Mager K, Schumacher M, Keil W. Variations of the frontal exit of the supraorbital nerve: an anatomic study. Plast Reconstr Surg. 1998;102:334-341.

    CAS  PubMed  Google Scholar 

  71. Hwang K, Hwang JH, Cho HJ, Kim DJ, Chung IH. Horizontal branch of the supraorbital nerve and temporal branch of the facial nerve. J Craniofac Surg. 2005;16:647-649. Discussion 650.

    PubMed  Google Scholar 

  72. Shankland WE II. The trigeminal nerve. Part III: the maxillary division. Cranio. 2001;19:78-83.

    PubMed  Google Scholar 

  73. Hwang K, Suh MS, Lee SI, Chung IH. Zygomaticotemporal nerve passage in the orbit and temporal area. J Craniofac Surg. 2004;15:209-214.

    PubMed  Google Scholar 

  74. Shankland WE II. The trigeminal nerve. Part IV: the mandibular division. Cranio. 2001;19:153-161.

    PubMed  Google Scholar 

  75. Kazkayasi M, Ergin A, Ersoy M, Tekdemir I, Elhan A. Microscopic anatomy of the infraorbital canal, nerve, and foramen. Otolaryngol Head Neck Surg. 2003;129:692-697.

    PubMed  Google Scholar 

  76. Canan S, Asim OM, Okan B, Ozek C, Alper M. Anatomic variations of the infraorbital foramen. Ann Plast Surg. 1999;43:613-617.

    CAS  PubMed  Google Scholar 

  77. Aziz SR, Marchena JM, Puran A. Anatomic characteristics of the infraorbital foramen: a cadaver study. J Oral Maxillofac Surg. 2000;58:992-996.

    CAS  PubMed  Google Scholar 

  78. Hu KS, Kwak HH, Song WC, et al. Branching patterns of the infraorbital nerve and topography within the infraorbital space. J Craniofac Surg. 2006;17:1111-1115.

    PubMed  Google Scholar 

  79. Hwang K, Nam YS, Choi HG, Han SH, Hwang SH. Cutaneous innervation of lower eyelid. J Craniofac Surg. 2008;19:1675-1677.

    PubMed  Google Scholar 

  80. Ginsberg LE, Eicher SA. Great auricular nerve: anatomy and imaging in a case of perineural tumor spread. AJNR Am J Neuroradiol. 2000;21:568-571.

    CAS  PubMed  Google Scholar 

  81. Hwang K, Lee WJ, Song YB, Chung IH. Vulnerability of the inferior alveolar nerve and mental nerve during genioplasty: an anatomic study. J Craniofac Surg. 2005;16:10-14. Discussion 14.

    PubMed  Google Scholar 

  82. Greenstein G, Tarnow D. The mental foramen and nerve: clinical and anatomical factors related to dental implant placement: a literature review. J Periodontol. 2006;77:1933-1943.

    PubMed  Google Scholar 

  83. Hwang K, Han JY, Chung IH, Hwang SH. Cutaneous sensory branch of the mylohyoid nerve. J Craniofac Surg. 2005;16:343-345. Discussion 346.

    PubMed  Google Scholar 

  84. Posnick JC, Zimbler AG, Grossman JA. Normal cutaneous sensibility of the face. Plast Reconstr Surg. 1990;86:429-433. Discussion 434-435.

    CAS  PubMed  Google Scholar 

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Siemionow, M.Z., Gharb, B.B., Rampazzo, A. (2011). The Face as a Sensory Organ. In: Siemionow, M. (eds) The Know-How of Face Transplantation. Springer, London. https://doi.org/10.1007/978-0-85729-253-7_2

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